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Introduction to health care psychology
Health care psychology is concerned with understanding how biology, behavior, and social context influence health and illness. Health psychologists work alongside other medical professionals in clinical settings, work on behaviour change in public health promotion, teach at universities, and conduct research. Although its early beginnings can be traced to the kindred field of clinical psychology, four different divisions within health psychology and one allied field have developed over time: clinical health psychology, occupational health psychology (an allied field), public health psychology, community health psychology, and critical health psychology.Marks, D. F., Murray, M., Evans, B., Willig, C., Woodall, & C., Sykes, C. (2005). Health psychology: Theory, research and practice (2nd ed.). Thousand Oaks, CA: Sage. Organizations closely associated with the field of health psychology include Division 38 of the American Psychological Association and the Division of Health Psychology of the British Psychological Association. Overview As Levant http://www.apadiv31.org/Coop/levant4.pdf points out: "Seven of the nine leading causes of death have significant behavioral components. At least 50% (and maybe as much as 75%) of all visits to primary care medical personnel are for problems with a psychological origin (including those who present with frank mental health problems and those who somaticize), or for problems with a psychologicalcomponent (including those with unhealthy lifestyle habits such as smoking, those with chronic illnesses, and those with medical compliance issues). Stated another way, one study found that less than 16% of somatic complaints had an identifiable organic cause." So recent advances in psychological, medical, and physiological research have led to a new way of thinking about health and illness. This conceptualization, which has been labeled the biopsychosocial model, views health and illness as the product of a combination of factors including biological characteristics (e.g., genetic predisposition), behavioral factors (e.g., lifestyle, stress, health beliefs), and social conditions (e.g., cultural influences, family relationships, social support). Psychologists who strive to understand how biological, behavioral, and social factors influence health and illness are called health psychologists. The term "health psychology" is often used synonymously with the terms "behavioral medicine" and "medical psychology". Health psychologists work with many different health care professionals (e.g., physicians, dentists, nurses, physician's assistants, dietitians, social workers, pharmacists, physical and occupational therapists, and chaplains) to conduct research and provide clinical assessments and treatment services. Many health psychologists focus on prevention research and interventions designed to promote health and reduce the risk of disease. While more than half of health psychologists provide clinical services as part of their duties, many health psychologists function in non-clinical roles, primarily involving teaching and research. Leading journals include the [http://www.sagepub.com/journalsProdDesc.nav?prodId=Journal200899 Journal of Health Psychology] and the [http://www.bpsjournals.co.uk/journals/bjhp/ British Journal of Health Psychology]. *'Clinical health psychology' (ClHP) is a term for a division of health psychology that reflects the fact that the field was originally a branch of clinical psychology. ClHP is also a major contributor to the field of behavioral medicine within psychiatry. Clinical practice includes education, the techniques of behavior change, and psychotherapy. In some countries, a clinical health psychologist, with additional training, can become a medical psychologist and, thereby, obtain prescription privileges. *'Occupational health psychology' (OHP) is a relatively new discipline allied with health psychology. The ancestry of OHP includes health psychology, industrial/organizational psychology, and occupational health.Everly, G. S., Jr. (1986). An introduction to occupational health psychology. In P. A. Keller & L. G. Ritt (Eds.), Innovations in clinical practice: A source book, Vol. 5 (pp. 331-338). Sarasota, FL: Professional Resource Exchange. OHP has own doctoral programs, journals, and professional organizations. The field is concerned with identifying psychosocial characteristics of workplaces that give rise to health-related problems in people who work. These problems can involve physical health (e.g., cardiovascular diseaseBosma, H., Marmot, M. G., Hemingway, H., Nicholson, A. C., Brunner, E., & Stansfeld, S. A. (1997). Low job control and risk of coronary heart disease in Whitehall II (prospective cohort) study. British Medical Journal, 314, 558-565.) or mental health (e.g., depressionTucker, J. S., Sinclair, R. R., & Thomas, J. L. (2005). The multilevel effects of occupational stressors on soldiers' well-being: Organizational attachment, and readiness. Journal of Occupational Health Psychology, 10, 276-299.). Examples of psychosocial characteristics of workplaces that OHP has investigated include amount of decision latitudeKarasek, R. A. (1979). Job demands, job decision latitude, and mental strain: Implications for job redesign. Administrative Science Quarterly, 24, 285-307. a worker can exercise and the supportiveness of supervisors.Moyle, P. (1998). Longitudinal influences of managerial support on employee well-being. Work & Stress, 12, 29-49 OHP is also concerned with the development and implementation of interventions that can prevent or ameliorate work-related health problems.Schmitt, L. (2007). OHP interventions: Wellness programs. Newsletter of the Society for Occupational Health Psychology, 1, 4-5. http://sohp.psy.uconn.edu/SOHPNewsletter11.pdf#Wellness In addition, OHP research has important implications for the economic success of organizations.Adkins, J. A. (1999). Promoting organizational health: The evolving practice of occupational health psychology. Professional Psychology: Research and Practice, 30, 129 137. Other research areas of concern to OHP include workplace incivilityCortina, L. M., Magley, V. J., Williams, J. H., & Langhout, R. D. (2001). Incivility in the workplace: Incidence and impact. Journal of Occupational Health Psychology, 6, 64-80. and violence,Kelloway, E. K., Barling, J., & Hurrell, J. J. (Eds). Handbook of workplace violence. Thousand Oaks, CA: Sage Publications. work-home carryover,Haines, V. Y. III, Marchand, A., & Harvey, S. (2006). Crossover of workplace aggression experiences in dual-earner couples. Journal of Occupational Health Psychology, 11, 305-314. unemploymentFeldt, T., Leskinen, E., & Kinnunen, U. (2005). Structural invariance and stability of sense of coherence: A longitudinal analysis of two groups with different employment experiences. Work & Stress, 19, 68-83. and downsizing,Moore, S., Grunberg, L., & Greenberg, E. (2004). Repeated downsizing contact: The effects of similar and dissimilar layoff experiences on work and well-being outcomes. Journal of Occupational Health Psychology, 9, 247-257. and workplace safetyKidd, P., Scharf, T., & Veazie, M. (1996) Linking stress and injury in the farming environment: A secondary analysis. Health Education Quarterly, 23, 224-237. and accident prevention.Williamson, A. M., & Feyer, A.-M.(1995). Causes of accidents and the time of day. Work & Stress, 9, 158-164. Two important OHP journals are the [http://www.apa.org/journals/ocp/ Journal of Occupational Health Psychology] and [http://www.tandf.co.uk/journals/tf/02678373.html Work & Stress]. Organizations closely associated with OHP include the Society for Occupational Health Psychology and the European Academy of Occupational Health Psychology. *'Public health psychology' (PHP) is population oriented. A major aim of PHP is to investigate potential causal links between psychosocial factors and health at the population level. PH psychologists present research results to educators, policy makers, and health care providers in order to promote better public health. PHP is allied to other public health disciplines including epidemiology, nutrition, genetics and biostatistics. Some PHP interventions are targeted toward at-risk population groups (e.g., undereducated, single pregnant women who smoke) and not the population as a whole (e.g., all pregnant women). *'Community health psychology' (CoHP) investigates community factors that contribute to the health and well-being of individuals who live in communities. CoHP also develops community-level interventions that are designed to combat disease and promote physical and mental health. The community often serves as the level of analysis, and is frequently sought as a partner in health-related interventions. *'Critical health psychology' (CrHP) is concerned with the distribution of power and the impact of power differentials on health experience and behavior, health care systems, and health policy. CrHP prioritizes social justice and the universal right to health for people of all races, genders, ages, and socioeconomic positions. A major concern is health inequalities. The CrH psychologist is an agent of change, not simply an analyst or cataloger. A leading organization in this area is the International Society of Critical Health Psychology. Health psychology is both a theoretical and applied field. Health psychologists employ diverse research methods. These methods include controlled randomized experiments, quasi-experiments, longitudinal studies, time-series designs, cross-sectional studies, and case-control studies as well as action research. Health psychologists study a broad range of variables including genotype, cardiovascular disease, smoking habits, religious beliefs, alcohol use, social support, living conditions, emotional state, social class, and much more. Some health psychologists treat individuals with sleep problems, headaches, alcohol problems, etc. Other health psychologists work to empower community members by helping community members gain control over their health and improve quality of life of entire communities. Objectives of health psychology Understanding behavioral and contextual factors Health psychologists conduct research to identify behaviors and experiences that promote health, give rise to illness, and influence the effectiveness of health care. They also recommend ways to improve health care and health-care policy.Sharman, S. J., Garry, M., Jacobsen, J. A., Loftus, E. F., & Ditto, P. H. (2008). False memories for end-of-life decisions. Health Psychology, 27, 291-296. Health psychologists have worked on developing ways to reduce smokingDusseldorp, E., van Elderen, T., & Maes, S. (1999). A meta-analysis of psychoeducational programs for coronary heart disease patients. Health Psychology, 18, 506-519. and improve daily nutritionResnicow, K., Jackson, A., Blissett, D., Wang, T., McCarty, F., Rahotep, S., & Periasamy, S. (2005). Results of the Healthy Body Healthy Spirit Trial. Health Psychology, 24, 339-348. in order to promote health and prevent illness. They have also studied the association between illness and individual characteristics. For example, health psychology has found a relation between the personality characteristics thrill seeking, impulsiveness, hostility/anger, emotional instability, and depression, on one hand, and high-risk driving, on the other.Beirness, D. J. (1993). Do we really drive as we live? The role of personality factors in road crashes. Alcohol, Drugs & Driving, 9, 129-143. Health psychology is also concerned with contextual factors, including economic, cultural, community, social, and lifestyle factors that influence health. The biopsychosocial model can help in understanding the relation between contextual factors and biology in affecting health. Physical addiction plays an important role in smoking cessation. However, seductive advertising also contributes to psychological dependency on tobacco.Pierce, J. P.. & Gilpin, E. A. (1995). A historical analysis of tobacco marketing and the uptake of smoking by youth in the United States: 1890-1977. Health Psychology, 14, 500-508. Research in occupational health psychology indicates that people in jobs that combine little decision latitude with a high psychological workload are at increased risk for cardiovascular disease.Johnson, J. V., Stewart, W., Hall, E. M., Fredlund, P. & Theorell, T. (1996). Long-term psychosocial work environment and cardiovascular mortality among Swedish men. American Journal of Public Health, 86, 324-331 Other OHP research reveals a relation between unemployment and elevations in blood pressure.Kasl, S. V., & Cobb, S. (1970). Blood pressure changes in men undergoing job loss: A preliminary report. Psychosomatic Medicine, 32, 19-38. OHP research also documents a relation between social class and cardiovascular disease.Marmot, M. G., & Theorell, T. (1988). Social class and cardiovascular disease: The contribution of work. International Journal of Health Services, 18, 659-674. Health psychologists also aim to change health behaviors for the dual purpose of helping people stay healthy and helping patients adhere to disease treatment regimens. Health psychologists employ cognitive behavior therapy and applied behavior analysis (also see behavior modification) for that purpose. Preventing illness Health psychologists work towards promoting health through behavioral change, as mentioned above; however, they attempt to prevent illness in other ways as well. Campaigns informed by health psychology have targeted tobacco use. Those least able to afford tobacco products consume them most. Tobacco provides individuals with a way controlling aversive emotional states accompanying daily experiences of stress that characterize the lives of deprived and vulnerable individuals.Whalen, C. K, Jamner, L. D., Henker, B., & Delfino, R. J. (2001). Smoking and moods in adolescents with depressive and aggressive dispositions: Evidence from surveys and electronic diaries. Health Psychology, 20, 99-111. Practitioners emphasize education and effective communication as a part of illness prevention because many people do not recognize, or minimize, the risk of illness present in their lives. Moreover, many individuals are often unable to apply their knowledge of health practices owing to everyday pressures and stresses. A common example of population-based attempts to motivate the smoking public to reduce its dependence on cigarettes is anti-smoking campaigns.Hershey, J. C., Niederdeppe, J., & Evans, W. D. (2005). The theory of 'truth': How counterindustry campaigns affect smoking behavior among teens. Health Psychology, 24, 22-31. Health psychologists also aim at educating health professionals, including physicians and nurses, in communicating effectively with patients in ways that overcome barriers to understanding, remembering, and implementing effective strategies for reducing exposures to risk factors and making health-enhancing behavior changes.Ogden, J., Bavalia, K., Bull, M., Frankum, S., Goldie, C., Gosslau, M., et al. (2004) 'I want more time with my doctor': A quantitative study of time and the consultation. Family Practice, 21, 479-483. There is also evidence from occupational health psychology that stress-reduction interventions at the workplace can be effective. For example, Kompier and his colleagues Kompier, M. A. J., Aust, B., van den Berg, A.-M., & Siegrist, J. (2000). Stress prevention in bus drivers: Evaluation of 13 natural experiments. Journal of Occupational Health Psychology, 5, 32-47. have shown that a number of interventions aimed at reducing stress in bus drivers has had beneficial effects for employees and bus companies. The effects of disease Health psychologists investigate how disease affects individuals' psychological well-being. An individual who becomes seriously ill or injured faces many different practical stressors. The stresssors include problems meeting medical and other bills; problems obtaining proper care when home from the hospital; obstacles to caring for dependents; having one's sense of self-reliance compromised; gaining a new, unwanted identity as a sick person; and so on. These stressors can lead to depression, reduced self-esteem, etc.Cassileth, B. R., Lusk, E. J., Strouse, T. B., Miller, D. S., Brown, L. L., Cross, P. A., & Tenaglia, A. N. (1984). Psychosocial status in chronic illness. New England Journal of Medicine, 311, 506-511. Health psychology also concerns itself with bettering the lives of individuals with terminal illness. When there is little hope of recovery, health psychologist therapists can improve the quality of life of the patient by helping the patient recover at least some his or her psychological well-being.Lander, D. A., & Graham-Pole, J. R. (2008). Love medicine for the dying and their caregivers: The body of evidence. Journal of Health Psychology, 13, 201-212. Health psychologists are also concerned with identifying the best ways for providing therapeutic services for the bereaved.O'Brien, J. M., Forrest, L. M., & Austin, A. E. (2002). Death of a partner: Perspectives of heterosexual and gay men. Journal of Health Psychology, 7, 317-328. Critical analysis of health policy Critical health psychologists explore how health policy can influence inequities, inequalities, and social injustice. These avenues of research expand the scope of health psychology beyond the level of individual health to an examination of the social and economic determinants of health both within and between regions and nations. The individualism of mainstream health psychology has been critiqued and deconstructed by critical health psychologists using newer qualitative methods and frameworks for investigating health experience and behavior.Marks, D. F., Murray, M., Evans, B., Willig, C., Woodall, & C., Sykes, C. (2005). Health psychology: Theory, research and practice (2nd ed.). Thousand Oaks, CA: Sage. Applications of Health Psychology Improving doctor-patient communication Health psychologists attempt to aid the process of communication between physicians and patients during medical consultations. There are many problems in this process, with patients showing a considerable lack of understanding of many medical terms, particularly anatomical terms (e.g., intestines).Boyle, C. M. (1970). Difference between patients' and doctors' interpretation of some common medical terms. British Medical Journal, 2, 286-289. One main area of research on this topic involves 'doctor-centered' or 'patient-centered' consultations. Doctor-centered consultations are generally directive, with the patient answering questions and playing less of a role in decision-making. Although this style is preferred by elderly people and others, many people dislike the sense of hierarchy or ignorance that it inspires. They prefer patient-centered consultations, which focus on the patient's needs, involve the doctor listening to the patient completely before making a decision, and involving the patient in the process of choosing treatment and finding a diagnosis.Dowsett, S. M., Saul, J. L., Butow, P. N., Dunn, S. M., Boyer, M. J., Findlow, R., & Dunsmore, J. (2000). Communication styles in the cancer consultation: Preferences for a patient-centred approach. Psycho-Oncology, 9, 147-156. Improving adherence to medical advice Getting people to follow medical advice and adhere to their treatment regimens is a difficult task for health psychologists. People often forget to take their pills or are inhibited by the side effects of their medicines. Failing to take prescribed medication is costly and wastes millions of usable medicines that could otherwise help other people. Estimated adherence rates are difficult to measure (see below); there is, however, evidence that adherence could be improved by tailoring treatment programs to individuals' daily lives.Clark, M., Hampson, S. E., Avery, L., & Simpson, R. (2004). Effects of a tailored lifestyle self-management intervention in patients with type 2 diabetes. British Journal Of Health Psychology, 9 (Pt 3), 365-79. Ways of measuring adherence Health psychologists have identified a number of ways of measuring patients' adherence to medical regimens. * Counting the number of pills in the medicine bottle - although this has problems with privacy and/or could be deemed patronizing or showing lack of trust in patients * Using self-reports - although patients may fail to return the self-report or lie about their adherence * Asking a doctor or health worker - although this presents problems on doctor-patient confidentiality * Using 'Trackcap' bottles, which track the number of times the bottle is opened; however, this either raises problems of informed consent or, if informed consent is obtained, influence through demand characteristics.Banyard, P. (2002). ''Psychology in practice: Health. London, England: Hodder & Stoughton Educational. Managing pain Health psychology attempts to find treatments to reduce and eliminate pain, as well as understand pain anomalies such as episodic analgesia, causalgia, neuralgia, and phantom limb pain. Although the task of measuring and describing pain has been problematic, the development of the McGill Pain QuestionnaireMelzack, R. (1975). The McGill Pain Questionnaire: Major properties and scoring methods. Pain, 1, 277-299. has helped make progress in this area. Treatments for pain involve patient-administered analgesia, acupuncture (found by Berman to be effective in reducing pain for osteoarthritis of the kneeBerman, B., Singh B.B., Lao, L., Langenberg, P. , Li, H., Hadhazy, V., Bareta, J., & Hochberg, M. (1999). A randomized trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee. Rheumatology, 38, 346-354.), biofeedback, and cognitive behavior therapy. Doctoral Programs in Health Psychology Universities in Australia * Deakin University Melbourne, Australia Universities in the United Kingdom *City University, London Universities in the United States * Appalachian State University * Bowling Green State University * City University of New York, Graduate School and University Center(health track) * Colorado State University * East Carolina University * Indiana University Purdue University, Indianapolis * Mount Sinai School of Medicine * Ohio University * Pennsylvania State University * San Diego State University and University of California, San Diego * State University of New York (SUNY) Upstate Medical University * Stony Brook University * Syracuse University * University of California, Los Angeles * University of California, Riverside * University of California, San Francisco (Post-doctoral program only) * University of Cincinnati * University of Colorado, Denver * University of Kansas * University of Miami * University of North Carolina at Charlotte * University of Pittsburgh * University of Rochester, School of Medicine & Dentistry (Post-doctoral fellowship, within clinical ψ) * University of South Florida * University of Texas Medical Branch, Galveston (Post-doctoral fellowship, within clinical health ψ) * VA Connecticut Healthcare System (Post-doctoral residency in clinical health ψ only) * Virginia Commonwealth University, Department of Psychiatry (Post-doctoral fellowship, within clinical health ψ) Yeshiva University (Ferkauf School of Psychology; Phd with health emphasis) Rutgers University (specialization in intradisciplinary [sic] health) Fordham University (clinical program with health specialization) Kent State University Canadian Universities * McGill University * University of British Columbia * York University Doctoral Programs in Occupational Health Psychology Universities in the United States *Bowling Green State University *Clemson University *Colorado State University *Kansas State University *Portland State University *University of California, Los Angeles *University of Connecticut *University of Houston *University of Minnesota *University of South Florida *University of Texas at Austin ' Of Special Interest ' *University of Nottingham See also * Body-mind * Chronic stress * Interdisciplinary treatment approach * Medical psychology * Occupational safety and health * Occupational health psychology * Psychosomatic medicine * Workplace stress References Bibliography * Marks, D. F., Murray, M., Evans, B., Willig, C., Woodall, C., & Sykes, C. (2005). Health psychology: Theory, research and practice (2nd ed.). London: Sage Publications. ISBN 978-1-4129-0336-3 * Michie, S., & Abraham, C. (Eds.). (2004). Health psychology in practice. London. BPS Blackwells. * Cohen, L.M., McChargue, D.E., & Collins, Jr. F.L. (Eds.). (2003). The health psychology handbook: Practical issues for the behavioral medicine specialist. Thousand Oaks, CA: Sage Publications. *Ogden, J. (2007). Health psychology: A textbook (4th ed.). Berkshire, England: Open University Press. *Quick, J. C., & Tetrick, L. E. (Eds.). (2003). Handbook of occupational health psychology. Washington, DC: American Psychological Association. *Taylor, S. E. (1990). Health psychology. American Psychologist, 45, 40-50. External links * 6th Biennial ISCHP Conference, Lausanne (Switzerland) 2009 * 5th Biennial ISCHP Conference, Boston (USA) 2007 * Division 38--Health Psychology--of the APA * Division of Health Psychology of the BPS * Society of Behavioral Medicine home page * Psychology wiki * European Academy of Occupational Health Psychology * Society for Occupational Health Psychology Category:Applied psychology Category:Psychosomatic medicine